CDC: Gap between rural and urban deaths increasing in US

From Becker’s:

The gap between preventable deaths rates in rural and urban areas widened for many health conditions between 2010 and 2017, according to the CDC’s Morbidity and Mortality Weekly report published Nov. 8.

The analysis builds off a 2017 CDC report, which found a higher percentage of preventable deaths in rural areas compared to urban areas. The CDC enhanced geographic classification and reviewed 2010-17 mortality data from the National Vital Statistics System to calculate the five leading causes of preventable death among people under age 80.

In both rural and urban regions, the five leading causes of death during 2010-17 were heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke. Together, these deaths accounted for about 61 percent of all deaths in 2017.

Why hospitals are a weak spot in U.S. cybersecurity

From Axios:

Over 32 million people have had their protected health information breached this year, in 311 hacking incidents against health care providers that are under investigation by the Department of Health and Human Services.

The big picture: Complex, bloated hospital systems are a glaring weak spot in U.S. cybersecurity — and there are limits on the government’s power to help.

In the Emergency Room, Patients’ Unmet Social Needs and Health Needs Converge

From Morning Consult:

Calculations using data from the Healthcare Cost and Utilization Project, the largest collection of longitudinal hospital care data in the United States, show that in 2016, Kentucky, Tennessee, Florida, South Carolina and Missouri saw the highest ratios of total visits to population — but not because their residents are inherently sicker. The analysis found performance on measures that historically fall outside the realm of health care — like education, employment and poverty concentration — had nearly as strong a relationship with ED use as health status.

Sheriff’s deputy shot, suspect killed in scuffle over gun inside hospital emergency department in North Carolina

From the Daily News:

A sheriff’s deputy was shot and a suspect who tried to grab his weapon was killed Wednesday morning in the emergency department of a North Carolina hospital, authorities said.

The shooting happened around 8:20 a.m. when the suspect, whose name has not been released, scuffled with a deputy from the Cumberland County Sheriff’s Office and ended up being fatally shot by a local police officer who was at the scene for an unrelated case, officials told reporters at a news conference.

How Sanford Health is retaining younger nurses

From Becker’s

Sioux Falls, S.D.-based Sanford Health recently launched a yearlong residency  program to help retain new nurses, according to the Grand Forks Herald

The program is meant to support nurses in their new job and encourage long-term careers with the organization, Meghan Goldammer, senior vice president of nursing and clinical services, told the Grand Forks Herald.

Sanford Health employs 8,200 nurses, and losing one costs the system up to $70,000, according to Ms. Goldammer.

America’s Largest Health Insurer Is Giving Apartments to Homeless People

From Bloomberg:

Insurers, including UnitedHealth, generally try to reduce costs by restricting medical care. They require prior authorization for expensive procedures, deny claims for care deemed inappropriate, and limit the drugs available on prescription plans. This is partly why the industry has a bad reputation—the perception that insurers are middlemen that profit by withholding needed care without adding value. It’s behind the argument Senators Bernie Sanders and Elizabeth Warren make for replacing private insurance with “Medicare for All.”

Brenner aims to reduce expenses not by denying care, but by spending more on social interventions, starting with housing. How to do it is still largely uncharted. “I don’t think we’ve figured any of this out,” he says. “We’re at a hopeful moment of recognizing how deep the problem is.” A trip to any big-city ER reveals the magnitude of the challenge.

Retrospective study suggests emergency department physicians are improving both outcomes and efficiency of care

Press Release:

As policymakers focus on improving health care value, there has been increasing attention to Emergency Department (ED) care, which is often thought to be high cost and of variable quality, according to policymakers and health care leaders. Yet despite rising ED costs and efforts to encourage alternative sources of acute care, such as going to an urgent care clinic or a primary care physician, one in five Americans visits an ED annually, a number that has continued to rise. However, alongside rising ED utilization has been a national trend toward admitting fewer ED patients to the hospital, as alternative payment models have proliferated and hospital capacity has declined. Yet, the impact of these trends on clinical outcomes is unclear, and there has been concern that they may lead to patient harm.

In a new study published today in JAMA Internal Medicine, a team of researchers led by Laura Burke, MD, MPH, an emergency medicine physician at Beth Israel Deaconess Medical Center (BIDMC), found that among Medicare beneficiaries receiving ED care in the United States, mortality within 30 days of an ED visit has declined in recent years, particularly for the highest-severity patients. These declines occurred as fewer patients were admitted and were instead sent home. In the context of declining admission rates through the ED, these findings appear to suggest that ED care in the U.S. may be improving meaningfully over time.

“It’s important for policymakers and researchers to consider trends in emergency care from a broader perspective,” said Burke, who is also an Assistant Professor of Emergency Medicine at Harvard Medical School. “Too often, people focus on ED visits as being very expensive and see the growing intensity of emergency care as wasteful or unnecessary – however, emergency physicians on the front lines know that appropriate intensity of care, such as running more tests and administering more treatments when indicated, can provide a lot of value to the health care system and, most importantly, to patients. They do so by providing timely diagnosis and treatment and often, preventing the need for a more expensive hospital admission. Our results also suggest that the evolving practice of emergency care may also be leading to better outcomes.”

In this retrospective study, Burke and colleagues looked at more than 15 million ED visits in the United States among traditional Medicare beneficiaries from 2009 to 2016. They looked at how often patients were admitted to the hospital – versus sent home from the ED – and whether this was changing over time. They also examined whether the time trends – changes in mortality rates over time for Medicare beneficiaries using the ED – were similar across different types of hospitals, including large academic medical centers, small community hospitals, urban hospitals and rural hospitals.  They also explored whether these trends were greater for the sickest ED patients compared to the healthiest.

Burke and colleagues found that mortality rates within 30 days of an ED visit improved by 23 percent from 2009 to 2016 – a trend that was greatest for the sickest patients. When extrapolated to national ED visit rates among Medicare beneficiaries, this translates to nearly 200,000 fewer deaths in 2016 than would have occurred if mortality rates had remained at 2009 levels. These improvements occurred even though EDs sent more patients home and admitted fewer to the hospital, suggesting that emergency physicians are improving both outcomes and efficiency of care. Additionally, non-profit, major teaching hospitals and urban hospitals saw the more significant improvement in mortality over time. Taken together, these findings suggest that overall outcomes of patients visiting the ED have improved.

“When researchers and policymakers studying emergency care look only at trends in patients who are discharged from the ED, as they commonly do, they may miss the fact that this pool of discharged patients is becoming increasingly complex over time as more patients who would’ve been hospitalized in the past are now being managed in the ED and sent home rather than deferring additional testing and treatment to the hospital setting,” said Burke. “Additionally, the fact that these gains were not equally distributed across hospitals means that there should be greater attention paid to those hospitals that have lagged behind and understanding how we can best help all hospitals improve.”

In addition to Burke, co-authors include Stephen K. Epstein, MD, MPP, and Ryan C. Burke, PhD, of the Department of Emergency Medicine at BIDMC; and E. John Orav, PhD, and Ashish K. Jha, MD, MPH, of Harvard T.H. Chan School of Public Health.

This work was funded by the Emergency Medicine Foundation “Value of Emergency Care” grant.

Burke reported receiving grants from the Association of American Medical Colleges outside the submitted work. The authors declare that there is no conflict of interest associated with their manuscript.

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding.

BIDMC is in the community with Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth, Anna Jaques Hospital, Cambridge Health Alliance, Lawrence General Hospital, Signature Healthcare, Beth Israel Deaconess HealthCare, Community Care Alliance and Atrius Health. BIDMC is also clinically affiliated with the Joslin Diabetes Center and Hebrew Rehabilitation Center and is a research partner of Dana-Farber/Harvard Cancer Center and the Jackson Laboratory. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

BIDMC is part of Beth Israel Lahey Health, a new health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,000 physicians and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.